health care study 2011 - health and retirement...
TRANSCRIPT
Draft
Place barcode label here
Health and Retirement Study: Health Care Study 2011
HOW TO FILL IN THIS QUESTIONNAIRE
Please answer the questions by:
Marking a box like this:
Writing a number in a box like this: 1 6
Sometimes you will find an instruction telling you which question to answer next like this:
Yes
No
-+ Go to Question B3
Please enter all dollar amounts in whole dollars.
Like this: $ , 4 .00
Please use a #2 pencil or black ball point pen.
Erase unwanted marks completely.
PLEASE START THE QUESTIONNAIRE AT QUESTION A1 ON PAGE 1
Draft
ABOUT THIS QUESTIONNAIRE
This questionnaire is a part of the Health and Retirement Study. We greatly value your past participation in the HRS, and we hope that you will find this questionnaire interesting to complete. As always, your answers are extremely important to us. Please remember that your participation is voluntary and that you may skip over any questions that you would prefer not to answer.
A Department of Health and Human Services Certificate of Confidentiality covers this research in order to help ensure your privacy. This certificate can help protect the investigators from being forced to release any research information that identifies you. Please note that we must report credible evidence of serious harm or abuse to any person to the authorities, but this questionnaire does not ask any questions about such topics.
It is very important that the questions be answered by the person whose name is printed on the front cover of this questionnaire (or by someone who knows this person well enough to answer the questions for them, if the addressee is unable to complete the questionnaire alone).
Many questions can be answered by placing an (X) in the box ( ) in front of your response. Some questions may not apply to you, and you will be instructed to skip them. When this occurs, you will find an arrow ( -+) from your answer to the next appropriate question number. When no special instruction is given for your response choice, please continue with the next question.
If you have any questions about the questionnaire, please feel free to call us at 1-855-647-6769.
THANK YOU!
SECTION A. HEALTH CARE ACCESS
Draft
1.
The first questions refer to your current health and recent health care experiences. Please answer the questions for the person whose first name is printed on the front cover of this questionnaire. Do not include information about health care for anyone else.
A1 Would you say your health is excellent, very good, good, fair, or poor? (Mark [X] ONE box.)
Excellent
Very Good
Good
Fair
Poor
A2 How many different times were you a patient in a hospital overnight in the last twelve months? (Write numbers)
A3 Aside from any hospital stays, how many times have you seen or talked to a medical doctor about your health, including emergency room or clinic visits, in the last twelve months? (Write numbers)
A4 In the last twelve months, have you obtained services from a Community Health Center or a free clinic? (Mark [X] ONE box.)
Yes
No
A5 How confident are you filling out medical forms by yourself? (Mark [X] ONE box.)
Extremely confident
Quite confident
Somewhat confident
A little confident
Not at all confident
SECTION A. HEALTH CARE ACCESS
Draft
2.
A6 Do you currently have any health insurance (including public programs like Medicare and Medicaid)? (Mark [X] ONE box.)
Yes
No -+ Go to Question A18 on page 4
A7 What kind of coverage do you have? (Mark [X] all that apply.)
Medicare
Medicaid
A plan provided by my employer, my spouse’s employer, or a former employer or union Insurance purchased directly from an insurance company or through a group such as AARP TRI-CARE, CHAMPUS, or CHAMP-VA
Other public coverage such as the Indian Health Service, SCHIP, or a program run by the state or county I get care from the Department of Veterans Affairs (VA)
Other, specify
A8 Which of these do you consider your PRIMARY coverage? (Mark [X] ONE box)
Medicare
Medicaid
A plan provided by my employer, my spouse’s employer, or a former employer or union Insurance purchased directly from an insurance company or through a group such as AARP TRI-CARE, CHAMPUS, or CHAMP-VA
Other public coverage such as the Indian Health Service, SCHIP, or a program run by the state or county
The Department of Veterans Affairs (VA)
Other, specify
SECTION A. HEALTH CARE ACCESS
Draft
3.
Thinking about the plan that provides your PRIMARY coverage, please answer the following:
A9 In the last 12 months, did you try to get any kind of care, tests, or treatment through your health plan? (Mark [X] ONE box)
Yes
No -+ Go to Question A11
A10 In the last 12 months, how often was it easy to get the care, tests, or treatment you thought you needed through your health plan? (Mark [X] ONE box.)
Never
Sometimes
Usually
Always
A11 In the last 12 months, did you try to get information or help from your health plan's customer service? (Mark [X] ONE box)
Yes
No -+ Go to Question
A14
on page 4
A12
A13
In the last 12 months, how often did your health plan's customer service give you the information or help you needed? (Mark [X] ONE box.)
Never
Sometimes
Usually
Always In the last 12 months, how often did your health plan's customer service staff treat you with courtesy and respect? (Mark [X] ONE box.)
Never
Sometimes
Usually
Always
SECTION A. HEALTH CARE ACCESS
Draft
4.
A14 In the last 12 months, did your health plan give you any forms to fill out? (Mark [X] ONE box)
Yes
No
-+ Go to Question A16
A15 In the last 12 months, how often were the forms from your health plan easy to fill out? (Mark [X] ONE box.)
Never
Sometimes
Usually
Always
A16 In the last twelve months, how often did you use the Internet (including email) to communicate with your health plan? (Mark [X] ONE box.)
Never
Sometimes
Usually
Always
A17 Overall, how satisfied are you with this health plan? (Mark [X] ONE box.)
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
A18 Thinking now over your whole life, have you EVER been denied insurance coverage because of a pre-existing condition? (Mark [X] ONE box)
Yes
No
SECTION A. HEALTH CARE ACCESS
Draft
5.
A19 Have you EVER had coverage with benefits that were limited because of a pre-existing condition? (Mark [X] ONE box)
Yes
No
A20 Is there a place that you USUALLY go to when you are sick or need advice about your health? (Mark [X] ONE box)
Yes
No -+ Go to Question A22
A21 What kind of place is it - a clinic, doctor's office, emergency room, or some other place? If there is more than one place you usually go, please tell us about the place you go to most often. (Mark [X] ONE box)
Clinic or health center
Doctor's office or HMO
Hospital emergency room
Hospital outpatient department
Some other place
I don't go to one place most often
A22 The next questions are about medical care you have received in the last twelve months. If there is a place you usually go when you are sick (that is, if you answered YES to A20), please tell us about the care you receive at that place. If there is NOT a place you usually go, please tell us about your experiences getting medical care in the last twelve months. In the last twelve months, how often did the doctors and nurses explain things in a way that is easy to understand? (Mark [X] ONE box)
Never
Sometimes
Usually
Always
SECTION A. HEALTH CARE ACCESS
Draft
6.
A23 In the last twelve months, how often did the doctors and nurses listen carefully to you? (Mark [X] ONE box)
Never
Sometimes
Usually
Always
A24 In the last twelve months, how often did the doctors and nurses show respect for what you had to say? (Mark [X] ONE box.)
Never
Sometimes
Usually
Always
A25 In the last twelve months, how often did the doctors and nurses spend enough time with you? (Mark [X] ONE box.)
Never
Sometimes
Usually
Always
A26 In the last twelve months, how often did you use the Internet (including email) to communicate with your doctors and nurses? (Mark [X] ONE box.)
Never
Sometimes
Usually
Always
SECTION A. HEALTH CARE ACCESS
Draft
7.
A27 Overall, how satisfied are you with the doctors and nurses that you have seen in the past twelve months? (Mark [X] ONE box.)
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
A28 In the last twelve months, did you have any trouble finding a general doctor or provider who would see you? (Mark [X] ONE box.)
Yes
No, I was able to find a general doctor without difficulty
-+ Go to Question A30
No, I did not need to see a general doctor -+ Go to Question A30
A29 What was the difficulty? (Mark [X] all that apply.)
They would not take my insurance
They did not have any appointments soon enough
They were not taking new patients at all
There are no general doctors near where I live
Other, specify
A30 In the last twelve months, did you have any trouble finding a specialist who would see you? (Mark [X] ONE box.)
Yes
No, I was able to find a specialist without difficulty
-+ Go to Question A33
No, I did not need to see a specialist -+ Go to Question
A33
on page 9
SECTION A. HEALTH CARE ACCESS
Draft
8.
A31 What was the difficulty? (Mark [X] all that apply.)
I had trouble obtaining a referral
They would not take my insurance
They did not have any appointments soon enough
They were not taking new patients at all
There are no specialists of the kind I needed near where I live
A32 What type of specialist(s) did you have trouble finding? (Mark [X] all that apply.)
Allergist
Cardiologist (heart doctor)
Dermatologist (skin doctor)
Gastroenterologist
General surgeon Gynecologist /
obstetrician Orthopedist /
orthopedic surgeon
Neurologist or neurosurgeon (nerve / brain specialist)
Oncologist (cancer doctor)
Ophthalmologist (eye doctor)
Otolaryngologist (ear, nose, and throat doctor)
Psychiatrist or other mental health provider
Pulmonologist (lung doctor)
Rheumatologist (arthritis / immune system doctor)
Urologist
Other, specify
SECTION A. HEALTH CARE ACCESS
Draft
9.
A33 In the last twelve months, did you have any trouble finding a provider of some other type (for example, a dentist or physical therapist) who would see you? (Mark [X] ONE box.)
Yes
No, I was able to find other providers without difficulty -+
No, I did not need to see any other types of providers -+
Go to Question Go to Question
A36 A36
A34 What type of provider did you have difficulty finding? (Mark [X] all that apply.)
Dentist
Physical therapist
Occupational therapist
Home care provider / visiting nurse
Pharmacist
Other, specify
A35 What was the difficulty? (Mark [X] all that apply.)
I had trouble obtaining a referral
They would not take my insurance
They did not have any appointments soon enough
They were not taking new patients at all
There are no specialists of the kind I needed near where I live
A36 In the last twelve months, was there any time when you needed medical care, but did not get it because you couldn't afford it? (Mark [X] ONE box.)
Yes
No
SECTION A. HEALTH CARE ACCESS
Draft
10.
A37 There are many reasons besides cost that people delay getting medical care. Have you delayed getting care for any of the following reasons in the last twelve months? (Mark [X] all that apply.)
I couldn't get through on the telephone
I couldn't get an appointment soon enough
Once I get there, I have to wait too long to see the doctor
The clinic / doctor’s office wasn't open when I could get there
I didn't have transportation
I am too busy to go to the doctor
I am afraid of what I might find out
I don't believe in going to doctors
I don't like going to the doctor
I have not delayed getting medical care in the last twelve months
-+ Go to Question A39
A38 What type(s) of care did you delay? (Mark [X] all that apply.)
Major surgery that would have required a hospital stay of one or more nights
Outpatient surgery
Seeing the doctor about a symptom or a problem
Getting a check-up
Routine screening, like a colonoscopy
Filling a prescription
Other, specify
A39 Overall, how satisfied are you with the quality of your health care? (Mark [X] ONE box.)
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
SECTION A. HEALTH CARE ACCESS
Draft
11.
A40 Overall, how satisfied are you with the cost of your health care? (Mark [X] ONE box.)
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
A41 Overall, how satisfied are you with the convenience of your health care? (Mark [X] ONE box.)
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
A42 Thinking about the quality, cost, and convenience of your health care, how satisfied are you overall? (Mark [X] ONE box.)
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
END OF SECTION A
SECTION B. POLICY
Draft
12.
The next set of questions is about policies related to health care programs.
B1 Please mark (X) a box on the line below indicating what you think is the percent chance that Congress will change the Medicare program sometime in the next 10 years, so that it becomes less generous than it is now? (Mark [X] ONE box.)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Surely won't happen
Surely will happen
Skip B2a through B2c if you answered "0%, Surely won't happen" to B1.
B2 Please indicate how likely it is that each of the following changes will be made to the Medicare program. (Mark [X] ONE box per row.)
Very likely
Somewhat likely
Neutral Somewhat unlikely
Very unlikely
Don't know
B2a It will become more expensive for Medicare enrollees to get the health care they need
B2b It will get harder for bene- ficiaries to find doctors who take Medicare patients
B2c Medicare enrollees will have to choose a private isurance company to provide their benefits
B3 As you may know, a health reform bill was signed into law early last year. How much if anything, have you seen, read, or heard about the new law? (Mark [X] ONE box.)
A lot
Some
Only a little
Nothing
Don't know
SECTION B. POLICY
Draft
13.
B4 Given what you know about the health reform law, how favorable or unfavorable is your opinion of it? (Mark [X] ONE box.)
Very favorable
Somewhat favorable
Neutral
Somewhat unfavorable
Very unfavorable
Don't know / it's too soon to tell
B5 Do you think each of the following groups will be better off or worse off under the health reform law, or don't you think it will make much difference? (Mark [X] ONE box per row.)
Better off Won't make
much difference Worse off Don't
know
B5a The country as a whole
B5b People with serious or chronic health problems
B5c You and your family
B5d People with pre-existing health conditions
B5e Young adults
SECTION B. POLICY
Draft
14.
B6 Thinking about how the health reform law will affect you and your family, what will happen to the amount you spend on health insurance premiums? (Mark [X] ONE box.)
It will go up a lot
It will go up a little
It will not change much
It will go down a little
It will go down a lot
Don't know
B7 Thinking about how the health reform law will affect you and your family, what will happen to the amount you spend out-of-pocket on health care? (Mark [X] ONE box.)
It will go up a lot
It will go up a little
It will not change much
It will go down a little
It will go down a lot
Don't know
B8 Thinking about how the health reform law will affect you and your family, will it make it easier or harder for you to get insurance coverage? (Mark [X] ONE box.)
It will be much harder
It will be somewhat harder
It will not change much
It will be somewhat easier
It will be much easier
Don't know
SECTION B. POLICY
Draft
15.
B9 Thinking about how the health reform law will affect you and your family, what will happen to the chance that medical expenses will use up all your savings in the next five years? (Mark [X] ONE box.)
It will be much more likely
It will be somewhat more likely
It will not change much
It will be somewhat less likely
It will be much less likely
Don't know
B10 Thinking about how the health reform law will affect you and your family, will it make it easier or harder for you to find a doctor who will see you? (Mark [X] ONE box.)
It will be much harder
It will be somewhat harder
It will not change much
It will be somewhat easier
It will be much easier
Don't know
END OF SECTION B
Draft
16.
SECTION C. LONG-TERM CARE
For purposes of this survey, when we use the term 'long-term care' we are referring to assistance with personal care needs such as dressing, bathing, getting in and out of bed, using the bathroom or eating.
C1 Not including government programs, do you have any long-term care insurance which specifically covers nursing home care for a year or more or any part of personal or medical care in your own home? (Mark [X] ONE box.)
Yes
No
-+ Go to Question C2
C1a In what year did you purchase this policy?
C1b Did you purchase your long-term care insurance policy through a current or past employer or spouse's employer? (Mark [X] ONE box.)
Yes
No
C2 Have you ever applied for long-term care insurance and had your application denied? (Mark [X] ONE box.)
Yes
No
C3 Has a family member or close friend ever spent a year or more in a nursing home? (Mark [X] ONE box.)
Yes
No
-+ Go to Question C5
on page 17
C4 What was that person's relationship(s) to you? (Mark [X] all that apply.)
Spouse / partner
Mother
Father
Sibling Close
friend Other,
specify
Draft
17.
SECTION C. LONG-TERM CARE
C5 Please mark each of the following statements as true or false: (Mark [X] ONE box per row.)
True False
C5a Medicare covers the extended use of long-term care for those age 65 or older
C5b Medicaid covers the extended use of long-term care for those who qualify on the basis of financial resources
C5c Most medigap / medicare supplemental insurance policies cover long-term care needs
If you are 85 years of age or older, please skip to C8 on page 18
C6 Assuming that you live to age 85, what is the chance that your mental and physical health will allow you to be living independently at that time, that is, to live at home without help and to manage your own affairs? Please mark (X) a box on the line below indicating what you think is the percent chance. (Mark [X] ONE box.)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Absolutely no chance
Absolutely
certain
C7 For a typical person of your age and gender who lives to age 85, what is the chance that his/her mental and physical health will allow him/her to be living independently at that time, that is, to live at home without help and to manage his/her own affairs? Please mark (X) a box on the line below indicating what you think is the percent chance. (Mark [X] ONE box.)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Absolutely no chance
Absolutely
certain
Draft
18.
SECTION C. LONG-TERM CARE
C8 On a scale of 0 to 100, what is the chance that you will live in a nursing home at some point in your life? Please mark (X) a box on the line below indicating what you think is the percent chance. If you currently live in a nursing home, please mark (X) "not applicable" below. (Mark [X] ONE box.)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Absolutely no chance
Not applicable; I currently live in a nursing home.
Absolutely
certain
C9 For a typical person of your age and gender, on a scale of 0 to 100, what is the chance that he/she will live in a nursing home at some point in his/her life? (Mark [X] ONE box.)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Absolutely no chance
Absolutely
certain
C10a Thinking about the future, would extra financial resources be more valuable to you (Mark [X] ONE box.)
when you are in poor health so that you can use the resources to provide for any long-term care services that you need?
or when you are in good health so that you can use the resources to pay for goods and services that you enjoy?
C10b Thinking about the future, would extra financial resources be more valuable to you (Mark [X] ONE box.)
when you are in poor health so that you can use the resources to provide for more or better care (assuming that your basic medical care is already paid for)?
or when you are in good health so that you can use the resources to pay for goods and services that you enjoy?
Draft
19.
SECTION C. LONG-TERM CARE
C10c Thinking about the future, would extra financial resources be more valuable to you (Mark [X] ONE box.)
when you are in poor health so that you can use the resources to pay for goods and services that you enjoy (assuming that your basic medical care is already paid for)?
or when you are in good health so that you can use the resources to pay for goods and services that you enjoy?
C11a Suppose there is a 50/50 chance that one year from now you will be living in a nursing home and a 50/50 chance that you will be healthy and living in your own home. Also suppose you are offered a choice of insurance policy that will either pay you $10,000 if you are healthy and living at home in which case you can spend the money on goods and services you enjoy, OR $10,000 if you are in a nursing home to help pay for care, OR you can divide the $10,000 across these two possibilities (such as $5,000 either way). Which of the following options would you prefer? (Mark [X] ONE box.)
I would like to receive $10,000 if I were healthy and living at home and $0 if I were in a nursing home
I would like to receive $7,500 if I were healthy and living at home and $2,500 if I were in a nursing home
I would like to receive $2,500 if I were healthy and living at home and $7,500 if I were in a nursing home
I would like to receive $0 if I were healthy and living at home and $10,000 if I were in a nursing home
SECTION C. LONG-TERM CARE
Draft
20.
C11b Suppose there is a 50/50 chance that one year from now you will be living in a nursing home and a 50/50 chance that you will be healthy and living in your own home. Also suppose you are offered a choice of insurance policy that will either pay you $10,000 if you are healthy and living at home in which case you can spend the money on goods and services you enjoy, OR $10,000 if you are in a nursing home where you can spend the money to buy more or better care, OR you can divide the $10,000 across these two possibilities (such as $5,000 either way). Which of the following options would you prefer? (Mark [X] ONE box.)
I would like to receive $10,000 if I were healthy and living at home and $0 if I were in a nursing home
I would like to receive $7,500 if I were healthy and living at home and $2,500 if I were in a nursing home
I would like to receive $2,500 if I were healthy and living at home and $7,500 if I were in a nursing home
I would like to receive $0 if I were healthy and living at home and $10,000 if I were in a nursing home
C11c Suppose there is a 50/50 chance that one year from now you will be living in a nursing home and a 50/50 chance that you will be healthy and living in your own home. Also suppose you are offered a choice of insurance policy that will either pay you $10,000 if you are healthy and living at home OR $10,000 if you are in a nursing home, OR you can divide the $10,000 across these two possibilities (such as $5,000 either way). Assume that in either case the cost of all needed medical care is covered and that you can use the additional money to buy goods and services that you enjoy or that make your life more comfortable. Which of the following options would you prefer? (Mark [X] ONE box.)
I would like to receive $10,000 if I were healthy and living at home and $0 if I were in a nursing home
I would like to receive $7,500 if I were healthy and living at home and $2,500 if I were in a nursing home
I would like to receive $2,500 if I were healthy and living at home and $7,500 if I were in a nursing home
I would like to receive $0 if I were healthy and living at home and $10,000 if I were in a nursing home
Draft
21.
SECTION C. LONG-TERM CARE
Please indicate whether you agree or disagree with the following statements. (Mark [X] ONE box per row.)
C12
Strongly agree
Somewhat agree
Neutral Somewhat disagree
Strongly disagree
C12a I have thought a lot about the possibility of needing long-term care
C12b If I need long-term care at some point, I would prefer to receive care from a professional aide or nurse rather than my spouse or other family member
C12c If a family member (other than a spouse) cares for me, I would feel obligated to compensate that person in some way
C12d It is a child's obligation to help a parent with long-term care needs
C12e It is important to leave a bequest to one's heirs
C12f Long-term care insurance policies are appropriately priced given the cost of the care they cover
C12g I am concerned that an insurance company might deny reasonable claims for long-term care
C12h I am concerned that, once I own a long-term care insurance policy, an insurance company might raise my premiums
C12i I am concerned that an insurance
company may not remain in business long enough to pay for my care
Continued on page 22
Draft
22.
SECTION C. LONG-TERM CARE
Please indicate whether you agree or disagree with the following statements. (Mark [X] ONE box per row.)
C12
Strongly agree
Somewhat agree
Neutral Somewhat disagree
Strongly disagree
C12j Long-term care insurance contracts are complicated and difficult to understand
C12k A financial advisor has suggested
that I buy long-term care insurance
END OF SECTION C
Draft
23.
SECTION D. USE OF SENIOR SERVICES PROGRAMS
D1 Many communities have special services available for seniors. Have you ever used any services sponsored by a senior services agency or a community organization intended to assist seniors? (Mark [X] ONE box.)
Yes
No
-+ Go to Section E
on page 25
D2 What kind of services did you use? (Mark [X] all that apply.)
Meals on wheels
Other food or nutrition services
Transportation services
Financial counseling
Help with filing my taxes
Help with Medicare or other health insurance benefits
Legal counseling or helpline
Elder abuse counseling or helpline
Supportive services for caregivers
Adult day care / respite care
Services for individuals with Alzheimer's or other dementia
Chore services
Help finding caregivers
Help finding volunteer opportunities
Exercise classes
Continuing education or recreation classes
I use the local senior center
Other social activities
Other, specify
SECTION D. USE OF SENIOR SERVICES PROGRAMS
24.
D3 Are you currently receiving any of these services? (Mark [X] all that apply.)
Meals on wheels
Other food or nutrition services
Transportation services
Financial counseling
Help with filing my taxes
Help with Medicare or other health insurance benefits
Legal counseling or helpline
Elder abuse counseling or helpline
Supportive services for caregivers
Adult day care / respite care
Services for individuals with Alzheimer's or other dementia
Chore services
Help finding caregivers
Help finding volunteer opportunities
Exercise classes
Continuing education or recreation classes
I use the local senior center
Other social activities
Other, specify
D4 What is the name of the organization or organization(s) in your area that provides these services? Please list up to three organizations, if applicable.
1.
2.
3.
END OF SECTION D Draft
SECTION E. VETERANS
Draft
25.
The following questions are for veterans of the United States military. Please complete this section only if you have ever served in the active military of the United States. If you have never served in the active military of the United States, please skip to page 29.
-+ Section F on
E1 When did you serve on active duty in the U.S. Armed Forces?
M M Y Y Y Y M M Y Y Y Y From - until -
E2 If you served more than once, please indicate additional periods of service here.
M M Y Y Y Y M M Y Y Y Y From - until -
M M Y Y Y Y M M Y Y Y Y From - until -
M M Y Y Y Y M M Y Y Y Y From - until -
E3 Do you have a VA service-connected disability rating? (Mark [X] ONE box.)
Yes
No
-+ Go to Question E5
on page 26
I don't know -+ Go to Question E5 on page 26
E4 Please mark the box that reflects your service-connected disability rating. (Mark [X] ONE box.)
Less than 10 percent
10 to 29 percent
30 to 49 percent
50 to 69 percent 70 percent or higher I don't know
SECTION E. VETERANS
Draft
26.
E5 Have you obtained medical care or prescription drugs from a Veterans' Administration facility in the last twelve months? (Mark [X] ONE box.)
Yes
No -+ Go to Question E8
E6 What kind of care did you obtain from the VA? (Mark [X] all that apply.)
Hospital inpatient care
Outpatient / doctor’s office care
Prescription drugs
Emergency care
Counseling or mental health services
Eye care or eyeglasses
Physical therapy
Other, specify
E7 Overall, how satisfied are you with the VA? (Mark [X] ONE box.)
Very satisfied -+ Go to Question E10
Somewhat satisfied -+ Go to Question E10
Neutral -+ Go to Question E10
Somewhat dissatisfied -+ Go to Question E10
Very dissatisfied -+ Go to Question E10 on page 27
E8 Are you eligible to receive services from the VA? (Mark [X] ONE box.)
Yes
No
-+ Go to Question
E10
Unsure -+ Go to Question E10 on page 27
SECTION E. VETERANS
Draft
27.
E9 Please tell us why you don't get services at the VA. (Mark [X] all that apply.)
I have other coverage
I don't live near a facility
I don't need any services
I prefer non-VA providers
It takes too long to get an appointment at the VA
Other, specify
The following questions are for all veterans, including those who do not use VA services.
E10 Have you obtained care from non-VA providers in the last twelve months? (Mark [X] ONE box.)
Yes
No -+ Go to Question E12
E11 What kind of care did you obtain from non-VA providers? (Mark [X] all that apply.)
Hospital inpatient care
Outpatient / doctor’s office care
Prescription drugs
Emergency care
Counseling or mental health services
Eye care or eyeglasses
Physical therapy
Other, specify
E12 In general, how would you rate the quality of care at the VA compared to non-VA providers? (Mark [X] ONE box.)
VA is much better VA is somewhat better They are about the same
Non-VA is somewhat better Non-VA is much better
SECTION E. VETERANS
28.
E13 Please indicate how you would rate the overall quality of VA care, compared with non-VA care, for the following types of services. (Mark [X] ONE box per row.)
VA is better
About the same
Non-VA is better
E13a Hospital inpatient care
E13b Outpatient / doctor's office care
E13c Prescription drugs
E13d Emergency care
E13e Counseling or mental health services
E13f Eye care or eyeglasses
E13g Physical therapy
E14 Please indicate how you would rate VA care, compared with non-VA care, on the following dimensions. (Mark [X] ONE box per row.)
VA is better
About the same
Non-VA is better
E14a I don't have to wait too long to get an appointment
E14b Once I arrive for my appointment, I do not have to wait too long in the waiting room
E14c I don't have to travel too far to get there
E14d Care is centered around my needs and preferences
E14e My providers are working as a team to care for me
E14f Doctors treat me with courtesy and respect
E14g Nurses, pharmacists and other non-physician providers treat me with courtesy and respect
E14h Receptionists and other staff treat me with courtesy and respect
END OF SECTION E Draft
29.
SECTION F. FINAL QUESTIONS FOR ALL RESPONDENTS
F1 Were the questions in this questionnaire answered by the person to whom this questionnaire was addressed, or did someone else answer for that person? (Mark [X] ONE box.)
Yes, the questions were answered by the person to whom the questionnaire was addressed
The questions were answered by that person's spouse or partner
The questions were answered by that person's son or daughter
The questions were answered by someone else: Please say if you are a relative, a friend, a care provider, or what:
F2 Approximately, how long did it take you to complete this questionnaire?
# of minutes
F3 Please add any comments that you wish in the space below: (All comments should be written inside the box.)
Thank you for your participation in this important survey! Draft
Please return your completed questionnaire in the pre-addressed postage paid envelope. If you have any questions about the questionnaire, please feel free to call us at 1-855-647-6769.
THANK YOU!
Conducted by: The Survey Research Center The University of Michigan
Sponsored by:
The National Institute on Aging
Draft